Most Relevant Information
Provider Data
| NPI Number: | 1003378373 |
| Provider Name: | MINA GRACE |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | 106S00000X |
Most Important Dates
| Enumeration Date: | 04/04/2019 |
| Last Updated: | 04/04/2019 |
Provider Practice Location
23502 LYONS AVE STE 304A
NEWHALL
CA
913212538
Practice Location Phone/Fax
| Phone: | 6617020166 |
| Fax: |
Provider Mailing Location
28563 LINDA VISTA ST
CANYON COUNTRY
CA
913873188
Provider Mailing Phone/Fax
| Phone: | 7144177647 |
| Fax: |